Ingeborg Jahn

Occupational risk factors for lung cancer in women: Results of a case‐control study in Germany

BACKGROUND To investigate the association between lung cancer and occupational factors in women. METHODS Six hundred eighty-six women with lung cancer and 712 controls matched for age and region were interviewed to gather occupational histories and information about other risk factors and confounders. Odds ratios (OR) and 95%-confidence intervals (CI) were calculated. RESULTS There were 11 cases and 2 controls who reported occupational asbestos exposure. Significantly elevated risks (P < 0.05, smoking-adjusted), were observed in the following industries: chemical, oil (OR 3.7), pottery, glass (OR 2.5), engine, vehicle building (OR 2.2), paper, wood, print (OR 1.9), cleaning service, hairdressing, housekeeping, waste disposal (OR 1.5); and occupations: assemblers, unskilled metal workers (OR 2.5), stock clerks, etc. (OR 1.6), restaurant owners and hoteliers (OR 2.7), as well as waitresses and travel attendants (OR 2.6). CONCLUSIONS The study provides evidence that both occupations previously observed as hazardous in males, and occupations of particular significance for women only, play a role in the risk of lung cancer in women.

Testicular cancer and electromagnetic fields (EMF) in the workplace: results of a population-based case–control study in Germany

Objectives: In a population-based case–control study, we examined the association of testicular cancer and electromagnetic fields (EMF) in the workplace. Methods: Incident cases (n = 269) were recruited between 1995 and 1997. A total of 797 controls matched on age and region were randomly selected from mandatory registries of residents. EMF exposure was assessed for five categories in standardized face-to-face interviews using closed questions. For each exposure category, odds ratios (OR) were calculated, stratified by age and region, and in a more complex model weighted by duration and distance using conditional logistic regression. Subgroup analyses were conducted for seminoma and non-seminoma and for blue- and white-collar workers. Additionally, potential radar exposure was individually assessed by experts based on all available information including free text. Results: There was no excess risk for cases who reported to have ever worked near the following: radar units (OR = 1.0; 95% CI = 0.60–1.75); radiofrequency emitters (OR = 0.9; 95% CI = 0.60–1.24); electrical machines (OR = 1.0; 95% CI = 0.72–1.33); high-voltage lines or high-voltage electrical transmission installations (OR & equals; 0.7; 95% CI = 0.38–1.18); or visual display units or complex electrical environments (OR = 0.9; 95% CI = 0.67–1.21). The results for the weighted exposure and subgroup analyses did not differ substantially. For radar exposure as assessed by the experts, the OR was 0.4 (95% CI = 0.13–1.16). Conclusions: EMF exposure in the workplace does not seem to be a relevant risk factor for testicular cancer in our study.

Primary prevention from the epidemiology perspective: three examples from the practice.

BackgroundPrimary prevention programmes are of increasing importance to reduce the impact of chronic diseases on the individual, institutional and societal level. However, most initiatives that develop and implement primary prevention programmes are not evaluated with scientific rigor. On the basis of three different projects we discuss necessary steps on the road to evidence-based primary prevention.DiscussionWe first discuss how to identify suitable target groups exploiting sophisticated statistical methods. This is illustrated using data from a health survey conducted in a federal state of Germany. A literature review is the more typical approach to identify target groups that is demonstrated using a European project on the prevention of childhood obesity. In the next step, modifiable risk factors and realistic targets of the intervention have to be specified. These determine the outcome measures that in turn are used for effect evaluation. Both, the target groups and the outcome measures, lay the ground for the study design and the definition of comparison groups as can be seen in our European project. This project also illustrates the development and implementation of a prevention programme. These may require active involvement of participants which can be achieved by participatory approaches taking into account the socio-cultural and living environment. Evaluation is of utmost importance for any intervention to assess structure, process and outcome according to rigid scientific criteria. Different approaches used for this are discussed and illustrated by a methodological project developed within a health promotion programme in a deprived area. Eventually the challenge of transferring an evidence-based intervention into practice and to achieve its sustainability is addressed.SummaryThis article describes a general roadmap to primary prevention comprising (1) the identification of target groups and settings, (2) the identification of modifiable risk factors and endpoints, (3) the development and implementation of an intervention programme, (4) the evaluation of structure, process and outcome and (5) the transfer of an evidence-based intervention into practice.

Lung cancer and exposure to man-made vitreous fibers: results from a pooled case-control study in Germany.

BACKGROUND To investigate the association between lung cancer and occupational exposure to man-made vitreous fibers (MMVF), a pooled analysis of two case-control studies was conducted in the years 1988-1994. METHODS The case series consisted of 3498 males who were histologically or cytologically verified primary lung cancer cases. 3541 male population controls were drawn at random from the general population and matched to cases by sex, age, and place of residence. To examine the relationship between MMVF and lung cancer we asked all study subjects who worked for at least 6 months as construction and installation workers whether they ever installed or removed insulations and what kind of insulation material they used. RESULTS Some 304 (8.7%) cases and 170 (4.8%) controls reported to have insulated with glass wool or mineral wool mats. Coded as ever/never exposed, the odds ratio was 1.48 (95% CI: 1.17-1.88), adjusted for smoking and asbestos. To be sure to exclude any confounding effect of asbestos, we tried to identify those cases and controls who insulated with glass wool or mineral wool mats only and never reported any asbestos exposure. For this group we calculated an odds ratio of 1.56 (95% CI: 0.92-2.65), after adjustment for smoking. An elevated risk was also estimated on the basis of an expert rating which was done for a subgroup of cases and controls. Ever exposure to MMVF (but not to asbestos) in this subgroup yielded an odds ratio of 1.30 (95% CI: 0.82-2.07). CONCLUSIONS Our study provides some indication for an excess risk of man-made vitreous fibers. This result also persists after adjustment for smoking and asbestos.

Sample selection and outcome evaluation in primary prevention

The practical implementation of evidence-based prevention programmes is a major challenge that requires a sound scientific basis. This paper refers to statistical aspects that are relevant in the planning phase of a primary prevention programme. First, a stepwise approach using graphical models and CHAID decision trees is presented to select subgroups of the population suitable for targeted intervention. Second, adequate statistical methods for sample size determination and for outcome evaluation to be used in the planning phase of a study are described. The IDEFICS project is presented as an example to illustrate the way leading from the aetiology of a disease to the design of a primary prevention programme, its implementation and its evaluation. The practical implications of the presented approaches and their methodological caveats are discussed.

Pet birds and risk of lung cancer in North-Western Germany

In a case-control study on lung cancer and occupational exposures, a subgroup of 144 cases and 253 population-based controls interviewed in the last 16 months of the study, were additionally asked about their exposure to pet birds and other pets. We used the same questionnaire as a previous German study that found a positive association between pet bird keeping and lung cancer. Odds ratios were calculated for lifetime and adulthood exposure respectively. The adjusted odds ratio for ever keeping pet birds was 0.85 (95% CI: 0.53-1.35), and 0.87 (95% CI: 0.56-1.36) for adulthood exposure. There was no evidence of a trend for increasing lung cancer risk with duration of pet bird keeping. With decreasing age at diagnosis, an apparent risk emerged, yielding an odds ratio of 7.62 (95% CI: 2.15-26.95) for ever versus never in the youngest age group (< or =55 years). This odds ratio was reduced to 3.82 (95% CI: 0.98-14.92) after adjustment for smoking and was only 1.39 (95% CI: 0.49-3.95) for adulthood exposure. In general, our results indicate that pet bird keeping does not seem to increase the risk of lung cancer. The divergent findings at younger ages may be explained by age-related recall bias, but should be investigated in future studies.

A population-based case-control study on social factors and risk of testicular germ cell tumours.

Objectives Incidence rates for testicular cancer have risen over the last few decades. Findings of an association between the risk of testicular cancer and social factors are controversial. The association of testicular cancer and different indicators of social factors were examined in this study. Design Case–control study. Setting Population-based multicentre study in four German regions (city states Bremen and Hamburg, the Saarland region and the city of Essen). Participants The study included 797 control participants and 266 participants newly diagnosed with testicular cancer of which 167 cases were classified as seminoma and 99 as non-seminoma. The age of study participants ranged from 15 to 69 years. Methods Social position was classified by educational attainment level, posteducational training, occupational sectors according to Erikson-Goldthorpe-Portocarrero (EGP) and the socioeconomic status (SES) on the basis of the International SocioEconomic Index of occupational status (ISEI). ORs and corresponding 95% CIs (95% CIs) were calculated for the whole study sample and for seminoma and non-seminoma separately. Results Testicular cancer risk was modestly increased among participants with an apprenticeship (OR=1.7 (95% CI 1.0 to 2.8)) or a university degree (OR=1.6 (95% CI 0.9 to 2.8)) relative to those whose education was limited to school. Analysis of occupational sectors revealed an excess risk for farmers and farm-related occupations. No clear trend was observed for the analyses according to the ISEI-scale. Conclusions Social factors based on occupational measures were not a risk factor for testicular cancer in this study. The elevated risk in farmers and farm-related occupations warrants further research including analysis of occupational exposures.

Geschlechtergerechte epidemiologische Datenanalyse: Methodische Aspekte und empirische Befunde

ZusammenfassungGeschlechtergerechte Forschungsansätze sind in Deutschland im Rahmen von Standards guter epidemiologischer Praxis sowie in der Gesundheitsberichterstattung (GBE) verankert. Sie werden zunehmend für die Umsetzung der Gender-Mainstreaming-Strategie in der Forschungsförderung von Bund und Ländern eingefordert. In diesem Artikel werden methodische Fragen der Datenanalyse in den Mittelpunkt gestellt und anhand eines empirischen Beispiels aus der GBE des Landes Bremen bearbeitet. Für diesen Artikel wurden die Daten einer bevölkerungsbezogenen Querschnittserhebung vertiefend ausgewertet. Die GBE benötigt Analyseund Berichterstattungsmethoden, die einerseits die geschlechterbezogenen Aspekte von Fragestellungen entdecken können und andererseits die Anforderungen an eine angemessene Kommunikation der Ergebnisse (Transferaspekt) berücksichtigen. Die Analyse beschäftigt sich hauptsächlich mit der Frage: Welche Auswirkungen hat der Einbezug der Kategorie Geschlecht in verschiedene statistische Auswertungsverfahren zur Identifizierung potenzieller Zielgruppen auf die Ergebnisse? Als Auswertungsmethoden wurden logistische Regressionsanalysen und ein 2-stufiges Verfahren explorativ eingesetzt. Dieses setzt sich aus graphischen Modellen und CHAID-Entscheidungsbaumanalysen zusammen und ermöglicht die Visualisierung komplexer Ergebnisse. Beide Methoden werden nach Geschlecht stratifiziert und kontrolliert analysiert und miteinander verglichen. Es zeigt sich, dass – solange auf kein Vorwissen für die Modellierung zurückgegriffen werden kann – nur stratifizierte Analysen Unterschiede zwischen den Geschlechtern und innerhalb der Genusgruppen entdecken können. Bei kontrollierten Analysen können Geschlechterunterschiede nur durch die Aufnahme geeigneter Interaktionsterme ermittelt werden. Die Ergebnisse werden aus statistisch-epidemiologischer Sicht sowie im Kontext der Anforderungen der GBE diskutiert. Es wird geschlussfolgert, dass die Frage nach der Geschlechtersensibilität von Auswertungsmethoden nur in Bezug auf konkrete Fragestellungen und Bedingungen beantwortet werden kann. Häufig wird eine Aussage über das angemessene statistische Vorgehen erst nach einer separaten Analyse für Frauen und Männer getroffen werden können. In Zukunft bedarf es sowohl der Entwicklung innovativer Studiendesigns als auch der konzeptionellen Klärung im Hinblick auf die biologischen und soziokulturellen Elemente der Kategorie Geschlecht.AbstractIn Germany gender-sensitive approaches are part of guidelines for good epidemiological practice as well as health reporting. They are increasingly claimed to realize the gender mainstreaming strategy in research funding by the federation and federal states. This paper focuses on methodological aspects of data analysis, as an empirical data example of which serves the health report of Bremen, a population-based cross-sectional study. Health reporting requires analysis and reporting methods that are able to discover sex/gender issues of questions, on the one hand, and consider how results can adequately be communicated, on the other hand. The core question is: Which consequences do a different inclusion of the category sex in different statistical analyses for identification of potential target groups have on the results? As evaluation methods logistic regressions as well as a two-stage procedure were exploratively conducted. This procedure combines graphical models with CHAID decision trees and allows for visualising complex results. Both methods are analysed by stratification as well as adjusted by sex/gender and compared with each other. As a result, only stratified analyses are able to detect differences between the sexes and within the sex/gender groups as long as one cannot resort to previous knowledge. Adjusted analyses can detect sex/gender differences only if interaction terms have been included in the model. Results are discussed from a statistical-epidemiological perspective as well as in the context of health reporting. As a conclusion, the question, if a statistical method is gender-sensitive, can only be answered by having concrete research questions and known conditions. Often, an appropriate statistic procedure can be chosen after conducting a separate analysis for women and men. Future gender studies deserve innovative study designs as well as conceptual distinctiveness with regard to the biological and the sociocultural elements of the category sex/gender.In Germany gender-sensitive approaches are part of guidelines for good epidemiological practice as well as health reporting. They are increasingly claimed to realize the gender mainstreaming strategy in research funding by the federation and federal states. This paper focuses on methodological aspects of data analysis, as an empirical data example of which serves the health report of Bremen, a population-based cross-sectional study. Health reporting requires analysis and reporting methods that are able to discover sex/gender issues of questions, on the one hand, and consider how results can adequately be communicated, on the other hand. The core question is: Which consequences do a different inclusion of the category sex in different statistical analyses for identification of potential target groups have on the results? As evaluation methods logistic regressions as well as a two-stage procedure were exploratively conducted. This procedure combines graphical models with CHAID decision trees and allows for visualising complex results. Both methods are analysed by stratification as well as adjusted by sex/gender and compared with each other. As a result, only stratified analyses are able to detect differences between the sexes and within the sex/gender groups as long as one cannot resort to previous knowledge. Adjusted analyses can detect sex/gender differences only if interaction terms have been included in the model. Results are discussed from a statistical-epidemiological perspective as well as in the context of health reporting. As a conclusion, the question, if a statistical method is gender-sensitive, can only be answered by having concrete research questions and known conditions. Often, an appropriate statistic procedure can be chosen after conducting a separate analysis for women and men. Future gender studies deserve innovative study designs as well as conceptual distinctiveness with regard to the biological and the sociocultural elements of the category sex/gender.

Geschlecht und Gesundheit

Geschlecht hat Konjunktur, zumindest in Form des zeitgeistigen Begriffs „Gender“ (bzw. Gender Mainstreaming): in der Politik, in der Praxis und auch in den Wissenschaften. In Diskussionen und öffentlichen Veranstaltungen über Gender Mainstreaming gilt die medizinische Gesundheitsforschung und -versorgung häufig als ein Positivbeispiel. Einige Argumente dafür sind: F Durch die Bedeutung soziokultureller und biologischer Unterschiede zwischen den Geschlechtern ist die Notwendigkeit einer Differenzierung in der gesundheitsbezogenen Forschung und Versorgung offensichtlicher und insofern leichter durchzusetzen. F Es gibt inzwischen eine unüberschaubare Fülle von Literatur zu verschiedenen Aspekten von Geschlecht und Gesundheit, zahlreiche Reviews und auch einige Handbücher (Beispiele für Handbücher aus dem deutschen Sprachraum sind [1, 2]1. F Forscherinnen und Forscher werden in der nationalen und internationalen Forschungsförderung zunehmend öfter und deutlicher auf die Berücksichtigung der Kategorie Geschlecht aufmerksam gemacht. F Es gibt eine „Gender“-Infrastruktur in Deutschland, z. B. das Zentrum für Geschlechterforschung in der Medizin an der Charité Berlin, das von der

Ernährungsalltag von Familien in sozial benachteiligten Lebenslagen

ZusammenfassungHintergrundEine ausgewogene Ernährung gilt als bedeutsam für die Gesundheit der Menschen. Die Grundlagen werden im Kindesalter und in den Familien gelegt. Ernährungsbezogene Prävention sollte früh beginnen und wichtige Bezugspersonen und -systeme einbeziehen.MethodeZiel dieser qualitativen Studie war es, den Ernährungsalltag von Eltern und Kindern in sozial benachteiligten Lebenslagen zu untersuchen. Hierzu wurden 17 Eltern, 16 Mütter und 1 Vater, mit Kindern im Alter zwischen 3 und 6Jahren, die in Kindertagesstätten betreut werden, mit Leitfadeninterviews befragt. Themen waren der Ernährungsalltag in der Familie, Hintergründe des Ernährungsverhaltens und -handelns sowie Wahrnehmung der ernährungsbezogenen Aktivitäten der Kindertagesstätten (Kita). Die Auswertung erfolgte nach der qualitativen Inhaltsanalyse.ErgebnisseDie Ergebnisse zeigen, dass Eltern von positiven Einflüssen der Kitas auf das Ernährungsverhalten der Kinder berichten. Zugleich werden grundlegende Veränderungen im familiären Ernährungsalltag von den Eltern eher mit biographischen Veränderungen, wie Mutterschaft – und nicht mit der Kita – in Verbindung gebracht.SchlussfolgerungEs kann gezeigt werden, wie die Kita über den Weg der Kinder das familiäre Ernährungshandeln beeinflussen kann.AbstractBackgroundA balanced diet is regarded as meaningful for the health of people. Foundations for a healthy diet are established in childhood and families. Therefore, nutritional prevention should start as early as possible and include important reference persons of the children.MethodThe aim of this qualitative study was to examine the diet routine of parents and children in disadvantaged situations. For this purpose, 17parents with kindergarten children were questioned by using semistructured interviews. Parents were asked about the daily routine in the family diet, about the background of the family eating behaviors and activities, and their perceptions regarding nutrition-related activities of the day care centers.ResultsResults show that parents report on many positive influences of day care centers on the diet behavior of children. Changes of the family diet routine are less associated with the day care center but rather with biographical changes, such as motherhood.ConclusionIt was shown that day care centers can influence the diet behavior of the family involving children as a communication channel.